POS0286 TREATMENT OF A LARGE COHORT OF CHILDHOOD CHRONIC IDIOPATHIC UVEITIS: A MULTICENTRIC LARGE COHORT
Authors: I. Maccora, C. Guly, C. De Libero, R. Caputo, A. Ramanan, G. Simonini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Childhood Chronic Idiopathic Uveitis (cCIU) is a severe ocular condition that account for the 40% of uveitis in children. Its timely and proper treatment is critical to prevent severe complications. <h3>Objectives</h3> The purpose of this study was to describe the treatments of a large cohort of cCIU. <h3>Methods</h3> This is a retrospective medical chart review study of cCIU followed at Meyer children's hospital IRCCS and Bristol Royal hospital for children (1<sup>st</sup> Jan2019 - 31<sup>st</sup> Jan 2020). Children were included if they have a diagnosis of CIU prior to 16 years old according to SUN. We collected demographic, clinical and laboratory data. Achievement of remission on treatment was evaluated as persistent inactivity for at least 3 months without drops and systemic corticosteroids. <h3>Results</h3> Data about 126 cCIU (61 female, median age at onset 9.3 years (3-16), ANA positive in 33 (77.6%)) were collected. 68 have anterior uveitis, 29 intermediate, 15 anterior + intermediate, 1 posterior and 13 panuveitis. Excluding the patient with posterior involvement, 97 children (77.6%) underwent to at least one systemic treatment, 65 (52%) to two, 18 (14.4%) to three and 2 (1.6%) to four (Infliximab and tacrolimus), with a median follow-up of 46 months (IQR 22-67). The first drug was administered after a median time of 5 months (IQR 2-10). Treatments performed were summarized in table 1. Among the first line treatment, children treated with adalimumab are more likely to achieve remission and maintain remission for a longer time after drug withdrawal compared to the other drugs (χ² 7.59 p 0.006 and p 0.036 respectively). No significant differences have been evaluated stratifying analysis for anatomical subtype, ANA status, ethnicity, sex, ESR and CRP at onset for achievement remission with the first line treatment. However, patients treated with methotrexate who did not achieve remission have lower visual acuity in LogMar (0.53 vs 0.36, Mann-Whitney U test p 0.02). The superiority of Adalimumab in terms of remission achievement was confirmed when it was used as second line treatment too (χ² 6.29 p 0.04), however they relapsed more frequently out of therapy (χ² 6.6 p 0.03). Moreover, with the II line treatment, panuveitis showed higher proportion of remission achievement with adalimumab and worse response to MMF (χ² 2 p 0.03). <h3>Conclusion</h3> Treatment of cCIU is extremely challenging, achieving remission with the first line treatment in only the 50% of patients. However, patients treated with adalimumab have better chance to achieve remission and patients who showed worse visual acuity at onset would benefit of a more aggressive treatment with biologics since onset. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Ilaria Maccora: None declared, Catherine Guly Consultant of: Eli Lilly and Company, Cinzia De Libero: None declared, Roberto Caputo: None declared, Athimalaipet Ramanan Speakers bureau: Speaker fees – Abbvie, Roche, UCB, Lilly, Novartis and SOBI, Consultant of: Consulting fees from Abbvie, Eli Lilly, UCB and Alimera, Employee of: Participation on a Data Safety Monitoring Board or Advisory Board: Eli Lilly, Gabriele Simonini: None declared.